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Outcomes

Aggressive Events (Cascading Effects)

5 10 15 20 25 MBPBS TAU Mean Number per Week AGGRESSIVE EVENTS Training Post Training

MBPBS vs. TAU Training: t(18) = 0.21, p = .84 (Cohen’s d = 0.09) Post-training: t(58) = 11.01, p < 0.001 (Cohen’s d = 2.84)

Outcomes

Physical Restraints (Staff Behavior Change)

2 4 6 8 10 12 14 16 18 MBPBS TAU Mean Number per Week PHYSICAL RESTRAINTS Training Post Training

MBPBS vs. TAU Training: t(18) = 3.62, p = 0.002 (Cohen’s d = 1.62). Post-training: t(58) = 1.73, p = 0.10 (Cohen’s d = 4.34).

Outcomes

Use of Stat (Emergency) Medicine for Aggression (Staff Behavior Change)

2 4 6 8 10 12 MBPBS TAU Mean Number per Week STAT MEDICINES Training Post Training

MBPBS vs. TAU Training: t(18) = 1.73, p = 0.10 (Cohen’s d = 0.77) Post-training: t(58) = 11.28, p < 0.001 (Cohen’s d = 2.91)

Outcomes

One-to-One Staffing (Agency Behavior Change)

1 2 3 4 5 6 7 8 MBPBS TAU Mean Number per Week 1:1 STAFFING Training Post Training

MBPBS vs. TAU Training: t(18) = 0.69, p = 0.50 Post-training: , t(58) = 14.80, p = 0.0001

Singh, N. N., Lancioni, G. E., Medvedev, O. N.., & Myers,

• R. E., Chan, J., McPherson,
• C. L., Jackman, M. M., &

Kim, E. (2018). Comparative effectiveness of caregiver training in mindfulness- based positive behavior support (MBPBS) and positive behavior support (PBS) in a randomized controlled trial. Mindfulness.

• Randomized controlled trial MBPBS vs. PBS (PBS)
• Staff: 60 (MBPBS), 63 (PBS)
• Adults with developmental disabilities: 40

(MBPBS),40(PBS)

• Average age of staff: 44 (MBPBS), 43 (PBS)
• Adults with developmental disabilities: 41

(MBPBS), 44 (PBS)

• Target variables:
• Aggressive behavior
• Staff Injury
• Peer Injury
• Physical restraints for aggressive behavior
• Stats (emergency) medicine use
• One-to-one staffing for aggressive behavior
• Staff perceived psychological stress
• Professional Quality of Life (ProQOL)
• Staff turnover
• Cost-benefit analysis
• Mindfulness training: 7-day intensive
• Data collected for 40 weeks

Component Analysis

Staff Outcomes

Perceived Psychological Stress on PSS-10

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Staff Outcomes

Compassion Satisfaction

• n ProQOL

Staff Outcomes

Staff Burnout

• n ProQOL

Staff Outcomes

Traumatic Stress

• n ProQOL

Staff Outcomes

• Number of staff who terminated

their employment with the agency:

• MBPBS: 1 staff in 40 weeks
• PBS: 6 staff in 40 weeks
• MBPBS condition had a marginally

significant effect (p = .05) compared to the PBS condition with standardized β

• f -0.22 that explained 5% of variance in

these data.

Staff Turnover

Comparative costs for 40 weeks MBPBS training versus 40 weeks PBS training

Singh, N. N., Lancioni, G. E., Karazsia., & Myers, R. E., Hwang, Y-S, & Anālayo, Bhikkhu (2019). Effects of Mindfulness-Based Positive Behavior Support (MBPBS) training are equally beneficial for mothers and children with ASD or with ID. Frontiers in Psychology, 10: 385

• Randomized controlled trial of MBPBS for

mothers of children with ASD or with ID

• Mothers: 47 (ASD), 45 (ID)
• Target variables:
• Meditation practice (minutes per day)
• Perceived Stress (PSS-10)
• Children’s aggressive behavior
• Children’s disruptive behavior
• Compliance with mother’s requests
• Mindfulness training: 3-day low intensity
• Data collected for 40 weeks

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Mothers’ Outcomes

Perceived Stress

Outcomes for Adolescents with ASD

Aggressive behavior Disruptive behavior Compliance with mother’s requests

Outcomes for Adolescents with ID

Aggressive behavior Disruptive behavior Compliance with mother’s requests

Component Analysis

• Aim
• To assess the effectiveness of the MBPBS

package, versus MB (mindfulness) alone, and PBS (alone) across parent (perceived psychological stress) and child (aggressive behavior, disruptive behavior, compliance with parental requests) variables

• Experimental Design
• Three-arm randomized controlled trial
• MBPBS vs. MB vs. PBS
• Four experimental phases:
• 10-week control condition
• Training in each active experimental condition
• 30-week implementation condition
• 3-years of followup post-implementation condition

MBPBS vs. MB vs. PBS

Parents’ Perceived Psychological Stress

10.00 15.00 20.00 25.00 30.00 35.00 W1 W10 W40 1 Year 2 Years 3 Years Stress Assessment Time Parent Stress (PSS) MBPBS MB PBS

Children’s Aggressive Behavior

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Children’s Disruptive Behavior Children’s Compliance with Requests

Long-term effects of Mindfulness- Based Positive Behavior Support (MBPBS) program on mothers and their children with Autism Spectrum Disorder: A randomized controlled trial—Year 1

The PREVENTION Study

CONSORT Diagram

MBPBS vs. Control

Procedures

• MBPBS
• 3-day stepped-care version of MBPBS protocol
• Control
• No experimental variables were manipulated
• The mothers utilized training and treatment

procedures available in their own communities.

• Follow-up
• Every 6 and 12 months for 3 years
• Data reported for Year 1

MBPBS vs. Control

Outcome Measures

• Mothers
• Parent stress (Perceived Stress Scale-10)—

measured 3 times: in the week before training (Pre); 6 months and 12 months following training

• Mothers’ meditation practice: Daily log of

meditation in minutes

MBPBS vs. Control

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Outcome Measures

• Children with ASD
• Experimental
• Inhibitory Control Task (Dinky Toys Task;

Kochanska et al., 2000).

• Children’s Behavior Questionnaire (Rothbart

et al., 2001)

• Anger/Frustration
• Attentional Focusing
• Impulsivity
• Inhibitory Control
• Physical Integration:
• Physical engagement in community activities in

the same places that children without disabilities live, learn, work and play

• Social integration:
• Social engagement in community activities with

children and adults other than those s/he lives with or are paid to provide services—with friends and people who are significant in the child’s life

• Physical aggression
• Hitting, biting, kicking, and slapping directed at
• thers

MBPBS vs. Control

Outcome Measures

• Changes in Mother-Child Interactions
• Mother’s engagement with her child
• Behavioral observation of video-taped

interactions

• 1 Hour
• Partial Interval Recording
• 10 sec observation, 5sec recording
• 240 intervals
• Context of engagement
• Child learning activities
• Child leisure activities
• Proportion of engagement leading to child

disruptive behavior

• Learning activities
• Leisure activities

MBPBS vs. Control

Trajectory of Mothers’ Daily Meditation

Note: * Significant mean difference between groups, p < .001 * * * *

Trajectory of Mothers’ Perceived Stress

22.36 24.14* 17.33* 28.03* 19.88* Note: * Significant mean difference between groups and over time, p < .001

Children’s Inhibitory Control Task

* * * * Note: * Significant mean difference between groups and over time, p < .001

Children’s Anger/Frustration

* * * * Note: * Significant mean difference between groups, p < .001

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Children’s Attentional Focusing

* * * * Note: * Significant mean difference between groups and over time, p < .001

Children’s Impulsivity

* * Note: * Significant mean difference between groups, p < .001 * *

Trajectory of Children’s Physical Integration

* * * * Note: * Significant mean difference between groups, p < .001

Trajectory of Children’s Social Integration

Note: * Significant mean difference between groups, p < .001 * * * *

Trajectory of Children’s Physical Aggression

Note: * Significant mean difference between groups, p < .001 * * * *

Trajectory of Mothers’ Engagement with Child

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Some thoughts on Implementation Science

• Intergenerational effects of trauma—

effects of trauma in one generation is evidenced in future generations

• Dutch Famine study (Ravelli, 1976)—the

impact of starvation of mothers was evident in the embryos of two subsequent generations (Roseboom et al., 2011).

• Effects of shocking father mice when coming

into contact with cherry blossoms, produces startle response to cherry blossoms in the next generation of mice (Dias & Ressler, 2014)

• Effects of traumatic events (e.g., holocaust,

9/11, witnessing shootings, etc.) is present in successive generations who have never experienced the initial events (Yehuda et al., 2016)

• An abundance of such research suggests that

transgenerational effects of trauma may be due to epigenetic alterations—how the DNA interacts with the environment in successive generations.

Epigenetic effects of MBPBS on families and their children with ASD or ID?

• How can we produce the positive effects
• f mindfulness training for parents and

their children in subsequent generations

• f children?
• Spillover and cascading effects of teaching

mindfulness to parents

• Teach mindfulness to parents as soon as their

child is diagnosed with a disability so that the child’s developmental trajectory is on a positive pathway to begin with, and then provide booster training as needed

• This will preempt the need to intervene when

the child’s developmental trajectory is already

• n a negative pathway, with aggressive and

disruptive behaviors firmly entrenched, and learning is compromised.

• Why wait for the emotional regulation rupture

to occur and then engage in the repair process?

TAKE HOME MESSAGE

for Behavior Analysts

• Our training in behavior analysis provides

us with the tools to develop and assess the effects of new programs, like mindfulness, especially if we can have a beginner’s mind

• The single-subject designs provide each of

us (and especially working behavior analysts) tools to assess how well our interventions work to alleviate the suffering of everyone working in the field

• f developmental disabilities—parents,

family members, teachers, paid support staff, and the individuals with developmental disabilities

• It is time to kick our practice up a notch!

On Mindfulness of the Breath for Behavior Analysts

• Should be fun (i.e., reinforcing)
• Should be easy (i.e., low response cost)
• Is experiential, experimental, and not

theoretical

• Practiced for 20 minutes a day to change

brain function

• Best time to practice is when you can
• Use informal mindfulness throughout the

day

• Be present for yourself and your clients

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Thank You and Namaste

nisingh@augusta.edu

If there is any merit in this presentation may it be shared by all sentient beings